0 SAID# : 2924 9 

### TRANSMITTA L O F OMAH ALEA D SIT E SOI L REMEDIATIO N FIL E FOLDE R DATE ; 1/1 5 ADDRESS : 150 8 OHI O S T REMEDIATIO N CONTRACTOR ; PRUDEN TTECHNOLOGIES . INC . YEAR ; 201( t 

### SOI L REMEDIATIO N PROPERT YFIL E FOLDE R DOCUMENT S m PR E AN D POS TVIDE O O F PORPERT Y(DVD ) E

J EXECUTIV E SUMMAR Y [ ^

EPA-PROVIDE D PROPERT YSKETC H m SIGNE D ACCES S AGREEMEN TFOR SUBJEC TPROPERT Y D SIGNE D ACCES S AGREEMENT{S ) FOR ADJACEN TPROPERT Y t d RESTORATIO N AGREEMEN T D SETTLEMEN TDOCUMENTS (I.E. , FOR DAMAG E O R T O REPLACE PLANTS , ETC. ) 0

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CONFIRMATIO N DAT A OM>HOTOGRAPH S ,

AS-BUIL TSKETCH H SATISFACTOR YRESTORATIO N SIGNE D B YPROPERT YOWNE R a PROPERT YCLOSE-OU TCHECKLIS TSIGNE D B YEP A D DESCRIPTIO N O F AREA S NO TMEETIN G RO D CLEANU P CRITERI A E l UTILIT YCLEARANCE S 0

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PROPERT YINFORMATIO N FRO M DOUGUV S COUNT YASSESSOR'S OFFIC E D D D 

### Q'^'^f y i\\- m SIGNATUR E DAT E 3021830 7 Superfun d

### PROPERT Y SUMMAR Y Date : /15/201 0 Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-0 6 TO# l Mont hof : Propert y Address : 150 8 OHI O S T A . EXECUTIV ESUMMAR Y A. 1 Issue s Encountered : NON E A. 2 Issue s Resolved : NON E A. 3 Uniqu e Findings : NON E A. 4 Othe r Relevan t Information : NON E CONFIRMATIO N SAMPLIN GDATA/RESULTS : F l = 17 6 PP M @ 13" ; F 2 = 11 7 PP M @ 13" ; B l = 74 3 PP M @ 13" ; B 2 = 32 1 PP M @ 13" ; N O EASEMEN T ATTACHMENT S 1 ) Property sketc hprovide dby EP A pursuan t t o contrac t specification s 2 ) Signe dAcces s Agreemen t includin g acces s agreement s require dfor crossin g othe r propertie s 3 ) Pre-Excavatio n digita l vide o clip/photograph s 4 ) Post-Excavatio n digita l vide o clip/photograph s 5 ) Documentatio n - Complete dClose-ou t Checklis t 6 ) As-Bui hsketch
i ) Shal l includ e final lea dlevel s v ) Legen d ii ) Contaminatio n lef t behin darea s vi ) Contracto r identificatio n iii ) Property addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e include din th e individua l property file, i f available , o r obtaine dinclude : i ) Pre-excavatio n agreement detail s (i f an y ar e mad e withth e property owner ) ii ) Property Statu s Formsigne db y property owne r iii ) Excavatio n digita l vide o in MPEG , WM V (Window s Medi aVideo ) o r SWF(Flas hPlayer ) forma t and/o r photograph s iv ) Signe dfor mverifyin g satisfactory restoratio n v ) Descriptio n o f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOGIES , INC .Fin d Record 

### Backfill :

Sampl e Area : 2924 9 - 150 8 OHI O S T Owner : D Owne rOccupie d Owne rName : jCHAPMA N Mrm S L Owne rAddressl : 

# r Owne rAddress2 : 2145 3 E 5 4 P L City : State : Zi p Code : (DENVE R ~ |C 0 J80249 - Owne rPhon e Alternat e Phone : 

# I

Contract : Contractor : JPRUDENT2010_ S Contrac t Optio n JOPTIO N 1 Remediatio n Quer yj Lea d Remainin g QueryJ Propert yDamag e Query

Use rProvide d Owne rInformatio n Owne rName : Owne rAddress :
City : State : Zi p Code : Owne rPhone : Alternat e Phone : 

# I

Assessment : Qualifyin g Grou p J40 0 Assessmen t Ma xXR F Valu e | 518.4 4 Resident : Residen t Name : 

# I Propert yAddress : 1150 8 OHI O S T Zi p Code : |68110 - Residen t Phon e 

# ITECHNOLOGIK ; tNC . 

# EP A Propert y Clos e Ou t Propert y # : 7^1'+' ^ Date/Time : Quad s Excavated : F ( r FZ . ^1^ ' / ^"2 - Propert y Address : 1^0 ^ OV^o^-^ . Owner' s Name : C\\j^i ^ ^»wiX< \ Contracto r Group : Pniden t Technologies , Inc. , Excavatio n Genera l Ye s N o 1 .

I f necessary , wer e th e correc l quadjrant(s) excavatedandrestored ? 

## J 2 .

I f necessary , wer e th e correct area s o f drip zone excavatedan drestored ? / 

### Gradin g So dan dVegetatio n Ye s N o 1 .

Doe s the gradin g aroundth e perimete r o

f th e hous e in excavatedarea s generall y slop e awa y fro mthe house ? / 2 .

Has sodbeen laidin all area s tha t wer e excavated ? 

# i 3 .

Doe s the sodappea r t

o be generall y health y andgrowing ? (Onl y evaluat e i f inspecte da t a3 0 da

y tim e period) 4 .

Ar e soddedarea s generally fimi an devenl y graded ? 5 .Ar e the joint s between the so dstrip s generally tight ? (Onl y evaluat e i

f inspecteda t a3 0 da y tim e period) 

# J 6 .Wa s the propert y grade dsuc htlia t wate r wil l no t pool o n tlie property ? / 7 .

Wa s dainag e l o landscaping o r plan t material s avoided ? 

# 1 Gates , Fence s an dRetainin g Wall s Ye s N o 1 .

Do gate s open andclos e freely ? (I f applicable ) / 2 .

Wer e al l gate s o r fence s taken dow n during restoratio n activitie s reinstalled ? (I f applicable ) / 3 .

Was damag e t o gate s or fence s avoided ? (I f applicable ) / 4 .

Wa s damag e l o retainin g wall s avoided ? (If applicable ) / Foundation , Sidin g an dGutter s Ye s N o 1 . Wa s damag e t o the siding o r trimavoided ? / 

### Wa s damag e t o the foundation avoided ? 

# 7 Wa s damag e t o window s avoided ? 

# 7 4 .

Wa s damag e t o window s o r doo r screen s avoided ? 

# 7 / 

### 5 .Wa s damag e to downspout s o r downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Yie s N o 

### Wa s damage t o drivewa y surface s avoided ? 2 .

Wa s damag e to walkwa y surface s avoided ? 

# y

## Owner s comments :

Inspectio n notes :

Remova l andrestoratio n activate s complete includin g th e 30-da y so dwarranty : EP A Representativ e A^^Si* , ^Date: ibiji i

## >RU D rHNDCDGIES . IN C 

### AS - BUIL T DRAWIN G OLS#2924 9 Dat e Excavated : 10/08/201 0 

### OMAH A LEA D SUPERFUN D SIT E IISEP A Signed-Of f Date : 

### 2924 9 Extefio rPain t Nort h Arro w Omah a Lea d Sit e Owne rName : COLORAD O CLASSI C PROP • Goo d Sit e Sketc h Address : 150 8 OHIOST • Poo r Phone : H' W: 

# 1 0 ^

No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbie r LA B Concentratio n Collecte d Finn : >\SKI 1 RS \ AJ - RYASCPXA-2924 9 F1 pp m 

### Ef D Date : n - ib - o L RYBSCPXA-2924 9 F2 

### D pp m Time ; 3 : i*;pf>-> . RYCSCPXA-2924 9 Bl 

## 5/ g pp m 

### D Sample s /Analyze d RYDSCPXA-2924 9 82 pp m «DgSCPX A203'I B -0 2 

# n pp m 

### D XR F Uni t /OO l Bool< : 77 3 r^OZSCPX A2024 0 -G i 

### D pp m 

### D Date : I- ? -J2'^ U • nPZ6CPXA-2024 0 -P2 - 

### D pp m 

### D Tim e ^XX . 

### D Staff : 

### y7s u Numt)e r of Sample s = Legend : F1 = Fron t Left , F2 = Fron t Rigtit , B1 = Bac k Left , B2 = Bac k Righ t DZ = Dri p Zone , GZ = Garden , PZ = Pla y Al l quadrant s ar e as viewe d fro m th e street , facin g propert y 

# ENTERE D NO V 2 7 200 6



# 6/8 . ^ 5 1 B2 = 32 l PPM ® 13 " Bl = 74 3 PP M (a 

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ie>Vo o: Si- - JRev4[ NO EASEMEN T CONTRAC T #: EP-S7-10-0 5 PRUDEN TTECHNOLOGIES , INC .

# SEPA Propert yCompletio n Agreemen t Thi s agreemen t document s th e completio n o f remova l activitie s performe do n th e belo w liste dproperty . Th e propert y owner' s signatur e indicate s tha t th e propert y owne r i s satisfie dwit hth e restoratio n o f th e subjec t property , an dtha t n o item s ar e i n question , now , o r a t an y tim e i n th e future , excludin g an y remainin g warrant y (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Propert y ID : Propert y Address : 

## /'So ^

nk/ n Owner : 

### y/ u o- ^

y^/^-y^U A Phone : 

### ^(s^'^/.'-yi-^j^ y Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item :

I agre e restoratio n i s completed . ^ L J I d o no t agre e restoratio n i s complete d a t (note d deficiencie s above )



## /Sj^^rt^odyyy^' O Owner' s Sig i Dat ePniden t Technologies . Inc . (Prudent ) i s unde rcontract wit h th e U . S . Hnvironmenia l Protectio n Agenc y(tPA ) t o clea n u p Iead contaminale d soil s at a numbe ro fpropertie s locate d i n Omaha , Nebraska , includin g th e prppcn ylocate d a t l-'O'i ' CA'-' O -'a^nx.-l ' __ , Th e l-P Arequests you rpermissio n t o allo wPruden t t o perfor m a soi l cleanu p a t thi s propert yt o remov e Icad-coniaminate d soil . B ysignin g thi s form , iji cpropert yowne rgrant s permissio n t o Pruden t l o perfor m activitie s relate d t o Ih e cleanu p includin g soi l sampling , remova l o f lead-contaminate d soil , an d restoratio n o fth e reference d propeit)' . I f yo u hav e an yquestion s abou t th e soi l clcnnti p plaiuic d fo ryou rproperly , pleas e contact Pruden t sout h ofTic c.fo rIh e Omah a Ixa d Sit e cicanup-n t (402 ) 7J3-1188 . Genera l question s abou t th e Omoli a L^a d Sit e cleanu p co n be directe d t o ih cEP APubli cInfurmalio n Centers a t (402 ) 731-304 5 (Soul h Omah a office ) o r(402 ) 991-958 3 (Nort h Omah a ofTice) .

, . KjiiUo mL.-^^'i ^ Propert yAcces s Grante d By : (Please Prin t Name )

. . / ?^/<^ ' ^y ^ 

# yy: A fZ^li/'Z " i'Srjd P Properl yOwne rSignature : y^u^/i^'''' \ ' ' '• ' (Signature ) (Dale ) PROPERT YINFORMATIO N (T o be complete d b yrtsidtn l nnd/o rpropert yowne r- pleas e print ) RESIDEN TNAME : (^Owner . j ) Rente r RESIDEN TADDRESS : 6VAV~ A/'C - L\\V' > I F RENTAL , PROPERT YOWNE D BY : OWNER' S MAILIN G ADDRESS ; OWNER' S TELEPHON E NUMBE R - HOME : J L WORK : AG E O F HOME? : YEARS . HO W LON G HAV E YO U LIVE D HERE ? YEARS . HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978 7 YE S NO NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE R O F CHILDRE NUNDE R 7 YEAR S OL D WH O PLA Y I NTH E YAR D FO R 5 HOUR S O R MOR E PE R WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTRY GATES , ETC. )

AUIHORIT YFO R ENVIRONMEN I Al . RESPONS E ACTIONS ; Th e activitie s l o b e implemente d b yEP Aunde rthi s agreemen t arcpursuan t t o Sectio n 10 4 o fCERCLA , 4 2 U.S.C . 9604 . EPA' s righ t ofacces s l o th e propertyi s provide d fo ri n Sectio n 104(e ) o f CERCI.A . 4 2 U.S . C 9605(e) , whic h provide s entryfo r"determinin g Ih cnee d fo rresponse , o rchoosin g o rtakin g an yrespons e actio n unde rthi s title , o rothenvis e enforcin g th e provision s o fth e lille. " 808 0 War d Parkway , Suit e 40 5 S60 0 S 1 0 S t 424 2 Medica l Drive , Suit e 425 0 Kansa s City . M O 6411 4 Omaha , Nebrask a 6810 7 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)733-118 8 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)733-188 3 Fax : (210 ) 579-657 7• • 

### 2924 9 Btterio f Paint . NCflhAlTO W Owne rName:::COLORAD O CLASSI C PROP Omah a Lea d Sit e • Good Address : 1508 OHI O S T^'* ® Sketc h Q Poo r Phone : H : w : 

# 1 g'Noepaiiii l Lea d Sampt e , . _ Sample s Coliecte d Sampl e Numbe r Concentratio n Coitecte d Ffrm : Kawt gs 1 AJ " RYASCPXA-2924 9 F l 

### H 7 7 pp m E f D Dafee : n ~ v b '-o L RYBSCPXA-2924 9 F2 

### *i3 0 p m [ ^ D Time : _Si±S^un ^ RYCSCPXA-2924 9 B 1 

### 5/ g ppn t E f D Sample s AnalyzE d RYDSCPXA-2924 9 8 2 

### 4^ 1 pp m Q ' D fiDZeCPXiyOi 203^ 0 02 . 

### •~ pp m D n XR F Unit : /0O 7 Bdcxk: 17 3 nCgGCrXA-g024 0 6 Z Date : /7'/2-( ^ npzcGPX/' L soa^o—PZ - 

### •" ' pp m D n Time : ^32 2 ^ I Staff : /%L J Numbe ro f Sample s = | A ^

[ Legend : F 1 = Fron t Left , F2 Fron t Right , 8 1 = Bac k Left , B 2 = Bac k Righ t DZ = Dri p Zone , G Z = Ganten , P Z ~ Play Al l quadrant s ar e a s viewe d f«> m ttl e stiset, . factn o property 

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# A Printed : De c 10,201 0 www . dcgis.org/dogi s

### 10/7/201 0 www.dhon.org/irthinternet/DHONNotic. . Creat e AnotherTicket ; i_Backjojrt h Inteme t Sen d Emai l i 

## YOURTICKE T NUMBE RI S  2611527 . Origina l Cal l Date : 10/07/1 0 Time : 1:2 1 p mOp : SIVA1896 7 Wor k t o Begi n Date : 10/12/1 0 Time : 1:4 5 p m State : N E County : DOUGLA S Place : OMAHA Address : 150 8 Street : OHI O S T Twp : 15 NRng : 13 E Sect-Qtr : 10-SE-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : Lea d Soi l Remediatio n Projec t Locatio n o f Work : LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (402)733-188 3 : UNSUR E CORNER S Company: PRUDEN T TECHNOLOGIE S Contac t Name : SIV AJAMPAM A Phone : (402)733-118 8 Wor k Bein g Don e For : EP A Dept h o f Excavation : 6 F T Corne r Lot : NFront : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N CXCATV MCINE B MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C 

## Utilit y Servic e Are a Contac t nmn e Numbe r TVp e Day : 402934046 9 CXCATV CO X COMMUNICATIONS , IN C HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 800289342 7 N O CAL LPER MCINE B MC I Alt : MEM O Emerg : 800289342 7 Day : 402504782 3 METROPOLITA N UTDJTIE S MUDO l SAND Y Alt : DISTRIC T Emeig : 402504797 0 Day : 402444719 7 CIT Y O FOMAHA - OMAHACO F RICHTRAFFI C Alt : 402444516 1 TRAFFICSEWE R Emerg : 402444516 0 dhon.org/irthintemet/.../MessageTextas. . 

### 1/ 210/7/201 0 ^^www.dhon.org/irthintemet/DHONNotic.. . 

## 0PPIXJPR5 O*^;TM"^*^* ^ ^ EU ^ LOCATIN G Day : 406728934 3

At 4062071494 Emerg : 888728934 3 QLNNEI C QWES T LOCALNETWOR K EL M LOCATIN G Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

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### ENVIRONMENTAL ENGINEERm GAN D CONSTRUCTIO N lEBMNOUkees , INC . 

### SOLUTION S 

## SIT ESAFt:T Y HAZARD ANALYSI S Address : ^-^i^ i B1I±Q__ST ^ 

## Excavatio n Date : U2lOZj P Crew : --/?Z^.:2:Z'::2zr.zC»ri£ctr o Backfil l Date :

Ite m Conditio n Hazard s Correctiv e Actio n Overhea dLine s Ga s Lin e Wate r Lin e 

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### seoosios t 424 2 Medica l Drive , Suit e 72S 0 Kansa s Gi|y.llO«411 4 Omaha , NctaMk a6810 7 Sa n Antonio , T X 7822 9 Phons : (816 ) 363-370 3 PtKNW : (402)733-118 8 Phone : (2t0 ) 822-958 8 Fax : (816)363-370 7 rax : (402)73»'1«8 3 Fax : (210)679-657 7• y * ' \

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